Provider Demographics
NPI:1972746550
Name:POLLY E. LEONARD, D.O., LTD
Entity Type:Organization
Organization Name:POLLY E. LEONARD, D.O., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-732-2031
Mailing Address - Street 1:390 TOLL GATE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4326
Mailing Address - Country:US
Mailing Address - Phone:401-732-2031
Mailing Address - Fax:401-732-2035
Practice Address - Street 1:390 TOLL GATE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4326
Practice Address - Country:US
Practice Address - Phone:401-732-2031
Practice Address - Fax:401-732-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002762Medicaid
RI089002762Medicare PIN
RIG93692Medicare UPIN